Provider Demographics
NPI:1609376649
Name:VIA VITAE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:VIA VITAE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:BABIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-208-7108
Mailing Address - Street 1:4511 JOHN TYLER HWY STE B
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-2415
Mailing Address - Country:US
Mailing Address - Phone:757-208-7108
Mailing Address - Fax:
Practice Address - Street 1:4511 JOHN TYLER HWY STE B
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2415
Practice Address - Country:US
Practice Address - Phone:757-208-7108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557448111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty